Yes. There is an unmet need. Because safe supply programs have a limited capacity in terms of the number of people they can take in, the number of those who benefit compared to the number of those who are not able to access it results in a lot of translation between those two patient groups, if we can say that. We know from the literature on methadone that methadone is widely diverted because of that unmet need as well. When we read that research on methadone, we know that people are distributing methadone to their friends and their family members who are in withdrawal, who may have just had an overdose or who are trying to get away from fentanyl. We know that clearly from that research.
That's what we see at the street level with people using safe supply as well. People will “divert”—and I would like to put air quotes around that—to their spouse who is in profound withdrawal. They may divert to their roommate who just had an overdose. This is being done out of caring and compassion, so I think it's really important that we be careful with the morality that we're overlaying on the word “diversion”. When I say “morality”, does that mean people don't sell it? I'm not sitting here and saying that. I am saying that we are actually not looking at it in its entire context, because we stigmatize people who use drugs. We always assume that they're doing a bad thing, when the research shows that they are doing loving things for the people around them.
You asked me to expand on the diversion protocols, and I did mention these to Mrs. Goodridge. As I said, every single person on my program submits a urine toxicology test every single time they come in to see me, which for most of my patients is once per week. We monitor those urine toxicology tests and we always do them sequentially, because we know there is a false negative rate in those. If we see people who do not have hydromorphone in their urine, our first step is actually to have a conversation with this patient, because we have a long-term relationship. Within this, we say, “Do you have enough food to eat? Do you have a partner who is taking these medications? Are you at risk for violence?”—outside a pharmacy, as the Conservative MPs have alluded to here. We talk to them about the problems they're experiencing and we seek to fix those.
As I said, we provide food security, and we can provide safety planning. We help women leave partners when that is necessary. The vast majority of the time, that solves the issue of what we're calling “diversion”. When it doesn't—